TREATMENTS FOR EPILEPSY

Drugs known as anticonvulsants

DRUG;- LAMOTRIGINE

What is lamotrigine used for ?

Lamotrigine is most often used in the treatment of epilepsy, to help control fits or blackouts. It is sometimes used with other antiepileptic drugs but can be used on its own. There are many other anticonvulsant drugs. It may be necessary to try several drugs in different doses or combinations to find the best therapy for you i.e. least side effects and maximum effect.

Lamotrigine is also being used to help as a mood stabiliser to help prevent depression returning when other mood stabilising drugs such as lithium and carbamazepine have not helped. It needs to be started slowly to reduce the possibility of side effects. It is not thought to be effective for mania, nor actually for treating an episode of depression itself.

How does lamotrigine work ?

Epileptic seizures (fits or blackouts) happen when abnormal electrical discharges, like a short circuit causing a spark, occur in the brain. There is a chemical messenger (or "neurotransmitter") in the brain called glutamate, which "excites" the brain. Lamotrigine may help to decrease the action of the "excitatory" glutamate in the brain. This will help to calm the brain down (or get it less "excited") and reduce the chance of fits occurring. This may also be how it works as a mood stabiliser.

How should I take it ?

The tablets should be swallowed with at least half a glass of water whilst sitting or standing, so that they reach the stomach and do not stick in the throat. The dispersible lamotrigine tablets should be popped into a glass of water, stirred with a spoon and the liquid swallowed when the tablet has disintegrated.

When should I take it ?

Take it as directed on the medicine label, usually at breakfast and at bedtime. It is particularly important to take this drug regularly each day as directed by your doctor to make sure that you are getting the best control of your illness from your medicine.

How long will lamotrigine take to work ?

Lamotrigine should start to work soon after you start taking it if you are taking it for epilepsy, but probably a bit longer if taking it as a mood stabiliser or for depression. It may, however, take some time for your doctor to get the right dose for you, and you will probably need to increase your dose gradually over several weeks to around 200mg a day, to reduce the chance of getting a skin rash.

How long will I need to keep taking lamotrigine for ?

Lamotrigine is a 'preventative medicine' and so will usually need to be taken for a long time. It is important that you keep taking this medication until your doctor tells you to stop. Do not stop taking it just because you feel better. If you stop it before you are advised to do so your condition may well get worse.

Is lamotrigine addictive ?

Lamotrigine is not thought to be habit forming. For further discussion, click here.

Can I stop taking lamotrigine suddenly ?

You should never stop taking this medication suddenly or without advice from your doctor as this might mean an increase in fits or blackouts. If your doctor decides that you no longer require this drug it will be withdrawn gradually (like any treatment for epilepsy) to make sure that your fits do not return. This will usually be by a slight reduction in your dose every few weeks. You should therefore not experience any problems.

What should I do if I forget to take a dose ?

Start again as soon as you remember unless it is almost time for your next dose, then go on as before. Do not try to catch up by taking two or more doses at once as you may get more side-effects. You should tell your doctor about this next time you meet. If you are ill and vomit your tablets you should take that dose again. Missing a dose can cause your fits to return. The amount in your bloodstream may drop below the level needed to control your fits.

If you have problems remembering your doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices which can be used to help you remember.

What sort of side-effects might occur ?

Table adapted from UK Psychiatric Pharmacy Group leaflets, with kind permission (www.ukppg.org.uk )

Do not be worried by this list of side effects. You may get none at all. There are other rare side-effects. If you develop any unusual symptoms ask your doctor about them next time you meet.

Will lamotrigine make me drowsy ?

You may feel sleepy and so you must take care if you are allowed to drive or when operating any type of machinery. This effect should wear off or at least reduce after you have been taking it for a while.

Will lamotrigine cause me to put on weight ?

It is not thought that lamotrigine causes any changes in weight. If, however, you do start to have problems with your weight tell your doctor next time you meet as he or she can arrange for you to see a dietician for advice.

Will it affect my sex life?

Drugs can affect desire (libido), arousal (erection) and orgasmic ability. Lamotrigine is not thought to significantly affect these, although rarely improvement in desire or libido has been reported.

Can I drink alcohol while I am taking lamotrigine ?

You should avoid alcohol while taking lamotrigine as it may make you feel more sleepy. This is particularly important if you are allowed to drive or operate machinery and you must seek advice on this.

Are there any foods or drinks that I should avoid ?

You should have no problems with any food or drink other than alcohol (see above).

Will lamotrigine affect my other medication ?

Tell your doctor of any medicines that you may be taking and also before starting or stopping any other drugs. Lamotrigine may interact with valproate ('Epilim', 'Convulex', 'Depakote') and carbamazepine ('Tegretol') and so your dose will need to be chosen carefully. This does not necessarily mean the drugs can not be used together, just that you may need to follow your doctors instructions very carefully. See also the next question about “the pill”.

If I am taking a contraceptive pill, will this be affected ?

Yes. Lamotrigine may reduce the effectiveness of oral contraceptives (the Pill) and oral contraceptives may reduce the effectiveness of lamotrigine.

What if I want to start a family or discover I'm pregnant?

It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:

Lamotrigine is classified as "C". There is no evidence of a teratogenic effect, but there is little information available at present and so you should seek personal advice from your GP, who may then if necessary seek further specialist advice. If you are taking this medicine for epilepsy, then you will need to also consider the risk of seizures as well.

Will I need blood tests ?

You should not need any blood tests with lamotrigine.

Can I drive whilst taking lamotrigine ?

People suffering from epilepsy may drive a motor vehicle (but not a heavy goods vehicle) provided they have been free from fits for one year or if they have only had fits in their sleep for three years. You should consult your doctor about driving.

It is essential that you report epilepsy as well as sudden disabling attacks of loss or partial loss of consciousness to the 'Driver and Vehicle Licensing Centre' (DVLC). The DVLC will then make a medical assessment of your condition consulting with your doctor(s) where necessary. For more information see leaflet 'D100' ('What you need to know about driving licensing') which is available from most post offices, or contact the Driver Enquiry Unit, DVLC, SWANSEA SA6 7JL. (Telephone: 01792 772151 between 8.15 am. to 4.30 pm. on Monday to Friday). You will need to quote your Driver Number whether you write or telephone. Your doctor will be able to advise you, and may wish to access the UK Driver and Vehicle Licensing Agency (DVLA) guidelines website, which has the current DVLA guidelines on anxiety/depression, psychotic disorders, mania and other conditions or for epilepsy. If your doctor advises you not to drive, and you continue to do so, the doctor can inform the DVLA directly, as he or she would be lawfully responsible were you to have an accident. Once told, the DVLA may wish to carry out an enquiry, but you are entitled to drive until there a decision is made.

If you are allowed to drive remember that lamotrigine can make you drowsy when you first start taking it and cause you to have difficulty concentrating. You must take great care when driving or operating any type of machinery.

Email your comments or feedback.
Several developments have been as a result of feedback from visitors.

No site can be entirely bias-free. No matter how hard someone tries, training and background will always influence your outlook. We have, however, tried to eliminate bias, and we hope you take these pages in the spirit in which they are provided i.e. a genuine attempt to inform, educate and support.

Information here is based on published data. References include the UK British National Formulary (BNF, published by the British Medical Association and Royal Pharmaceutical Society of Great Britain), Martindale (the extra pharmacopoea, published by RPSGB Pharmaceutical Press), Psychotropic Drug Directory (latest edition), Data Sheet Compendium (UK Manufacturers Data Sheets, published by the Association of British Pharmaceutical Industry), MicroMedex (an independent and extensive CD-ROM based drug information source), UK Psychiatric Pharmacy Group leaflets, Royal College of Psychiatrists advice and guidelines and the current medical literature. Thanks also to all those people who left e-mail comments, suggestions and requests, who have helped shape the site.  

Email your comments or feedback.
Many developments have been as a result of feedback from visitors.

No site can be entirely bias-free. No matter how hard someone tries, training and background will always influence your outlook. We have, however, tried to eliminate bias, and we hope you take these pages in the spirit in which they are provided i.e. a genuine attempt to inform, educate and support.

Information here is based on published data. References include the UK British National Formulary (BNF, published by the British Medical Association and Royal Pharmaceutical Society of Great Britain), Martindale (the extra pharmacopoea, published by RPSGB Pharmaceutical Press), Psychotropic Drug Directory (latest edition), Data Sheet Compendium (UK Manufacturers Data Sheets, published by the Association of British Pharmaceutical Industry), MicroMedex (an independent and extensive CD-ROM based drug information source), UK Psychiatric Pharmacy Group leaflets, Royal College of Psychiatrists advice and guidelines and the current medical literature. Thanks also to all those people who left e-mail comments, suggestions and requests, who have helped shape the site.